经直肠超声引导两种13针方案在前列腺穿刺活检中的对比研究

Comparision between two methods for transrectal prostate biopsy under transrectal ultrasound guidance

目的对比6区12＋X针与5区13针两种布针方案在经直肠超声引导前列腺穿刺活检中的阳性率及并发症发生率的差异。方法选取我院经直肠超声引导下行前列腺穿刺活检术的患者161例,根据穿刺方案不同分为6区12＋X针组86例和5区13针组75例,比较两组的穿刺阳性率、出血率及肉眼血尿发生率;同时根据前列腺特异性抗原（PSA）分别将两组各分成≤10 ng/ml、10-20 ng/ml、≥20 ng/ml三个亚组,比较两组不同PSA水平穿刺阳性率的差异。结果 ①6区12＋X针组和5区13针组穿刺阳性率分别为33.7%（29/86）、21.3%（16/75）,两组比较差异有统计学意义（P〈0.05）;且随着PSA的升高,两组穿刺阳性率均升高,两组PSA≤10 ng/ml的穿刺阳性率比较差异有统计学意义（P〈0.05）;②6区12＋X针组与5区13针组的出血发生率分别为10.5%（9/86）、8.0%（6/75）;肉眼血尿发生率分别为18.6%（16/86）、29.3%（22/75）,差异均无统计学意义。结论 6区12＋X穿刺方案可提高实验室指标在诊断盲区的前列腺癌的检出率,且不会增加并发症的发生率,值得推广使用。

Objective To compare the difference of positive rate and complication rate between two methods in transrectal prostate biopsy between the 6 district 12＋X program and the 5 district classic 13-pin program. Methods One hundred and sixty-one cases of prostate biopsy under trans-rectal ultrasound guidance were divided into two groups according to the biopsy plan（86 cases of 6 district 12＋X program,and 75 cases of the 5 district classic 13-pin program）. The positive rate,bleeding probability and the gross hematuria probability after biopsy between two groups were compared. According to the prostate specific antigen（PSA）level,patients in two groups were divided into three subgroups（PSA≤10 ng/ml,10-20 ng/ml,≥20 ng/ml）. The PSA level was compared with the positive prostate cancer rate. Results ①The positive rate was 33.7%（29/86）and 21.3%（16/75）for6 district 12＋X program and 5 district 13 program,respectively,there was significant difference（P〈0.05）. The positive rate was increased with the PSA increasing. There was significant differences between the two program when PSA ≤10 ng/ml（P0.05）.②The chance of bleeding caused by the former program and the latter one were 10.5%（9/86）and 8.0%（6/75）,respectively,the chance of gross hematuria caused by the former program and the latter program were 18.6%（16/86） and 29.3%（22/75）. The difference was not statistically significant between the two programs. Conclusion The 6 district 12＋X puncture program is a safe and effective puncture method,and can improve the positive rate without serious complications when the PSA level was in blinded region.